*3.3.1.2 Peripheral arterial disease*

Documenting the presence and the severity of ischemia is extremely important. Examination includes: a) palpation of peripheral pulses at the dorsalis pedis and the posterior tibial arteries; b) measurement of the ankle-brachial index (ABI) by a Doppler device [99, 100]. ABI evaluates the ratio of systolic arterial pressure at the brachial over the ankle level [107, 108]. Normal values range between 0.9-1.3, while values exceeding 1.3 point to calcified, uncompressible arteries, in which case the test cannot be used [99]. Similarly, one may measure the toe-brachial index (TBI), given that small digital arteries are rarely calcified: TBI<0.7 confirms the diagnosis of PAD [108]. More sophisticated evaluation (ultrasound, angiography) are used when necessary, especially to guide interventional treatment [95–99].
